Caregiving Resource Center

Advance Directive: Creating a Living Will and Health Care Power of Attorney

En español | By thinking ahead and communicating treatment preferences early on, your loved one can prevent arguments and spare those close to him the anxiety of having to guess his wishes. Most important, he will have the opportunity to make very personal health care decisions for himself. These documents — called advanced directives — serve as a record of someone’s medical preferences.

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Putting Preferences in Writing
To record his medical preferences, your loved one will need to complete written documents called advance directive forms. There are two types of advance directives, and it’s important to have both:

1) A living will spells out what types of medical treatment a person wants at the end of life if he’s unable to speak for himself. It tells medical professionals a person’s wishes regarding specific decisions, such as whether to accept mechanical ventilation.

2) A health care power of attorney appoints someone to make health care decisions — and not just decisions regarding life-prolonging treatments — on one’s behalf. The appointed health care agent (also called an attorney-in-fact or proxy) becomes the patient’s spokesman and advocate on a range of medical treatments the patient sets out in the document. Of course, the health care agent makes decisions only when the patient can’t communicate on his own. This type of document is sometimes referred to as a health care proxy, appointment of a health care agent or durable power of attorney for health care. It is different from a regular durable power of attorney, which typically covers only financial matters.

Many states combine the two forms into one document, which can be used to record one’s treatment preferences and name a health care advocate.

The person your loved one appoints as his health care agent should know him well and be willing to carry out the directions your loved one has given to the agent regardless of personal feelings or influence from family and friends. Your loved one should be sure to name an alternate agent to stand in if the primary agent is not available.

In addition to recording his wishes in advance directive documents, your loved one should discuss his values and health care goals with his agent. While decisions about medical treatment often take center stage, there are other things your loved one may want to mention. As the end draws near, some people find comfort in listening to music or having their favorite poems read. Others want family and friends to pray for them. Part of making his wishes known is sharing what’s important to him.

Your loved one does not need to work with an attorney to create advance directives. However, state law may require that he sign the documents in the presence of one or more witnesses.

The Aging with Dignity website offers an easy-to-fill-out “Five Wishes” template for recording one’s medical treatment preferences. It meets legal requirements in 42 states, and people in other states often attach it to their state forms. You can use our online resource to get state forms.

Making Wishes Known
Once your loved one has completed his advance directive forms, he should make sure his health care agent has copies. He also should discuss his advance directives with his physicians and have copies placed in his medical records. If a doctor seems uncomfortable following his wishes, he should consider changing health care providers.

Your loved one also should keep copies of his advance directives in a safe and accessible place at home. He should specify their location in the letter of instruction that accompanies his will. No one wants to dig through papers in the middle of a family crisis.

Planning for medical decisions without knowing what issues might arise isn’t easy, but it’s the responsible, compassionate thing to do for one’s family. And when the time comes, knowing your loved one’s wishes will give you peace of mind.